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Posted on Sun, Mar 28, 2010 : 6 a.m.

Healthcare reform law benefits all Americans

By kiddoc

The healthcare system is confusing, even to those who work in it. The president’s signing of health insurance reform into law this past week represents a fundamental shift in our healthcare system with expanded coverage to more than 30 million previously uninsured Americans. The new law also serves to simplify the health system for millions of Americans and to those who provide care them.

Sarah, a newborn, was born healthy but a few weeks early. She stayed in the hospital for a couple of extra days until she was old enough to eat on her own, not an uncommon problem for newborn babies born a bit early. Soon after she was born, her father changed jobs from a large employer who offered health insurance to one who did not. In order to get coverage for his family, her father looked for coverage on the open market. Even though Sarah was healthy, because she was saddled with the “pre-existing condition” of prematurity (being born early) she was denied coverage. Sarah would go without normal check-ups at her doctor’s office and without needed preventive services like vaccines. Sarah’s story was not uncommon before the president signed the health reform law. Sarah, like many others, will be helped by the new health reform law.

To understand changes that will take place in our healthcare system, it is important to start by understanding where people currently get their health insurance coverage. Most people of the United States get their health insurance coverage from their employer. Those who cannot get coverage from their employer purchase insurance on the open market. For the elderly, Medicare provides coverage for those 65 and older regardless of income. As a safety net, Medicaid provides coverage for poor children, pregnant women, disabled adults and the elderly. Lastly, the Children’s Health Insurance Program (CHIP) provides coverage for low-income children who do not qualify for Medicaid. Those like Sarah, not poor enough to qualify for CHIP or Medicaid are left among the remaining 15 percent of the US population who are uninsured.

The general principle of the health reform law includes regulating the private insurance market to protect patients, creating a marketplace for people to purchase affordable private insurance coverage and reigns in the costs of health care. By asking everyone to have insurance coverage, the law aims to bring everyone into the health marketplace to bring costs down for us all.

How do the uninsured gain coverage?

The law creates health insurance exchanges for people and small businesses to purchase health insurance on the open market. Small businesses and middle-class workers can receive tax credits on a sliding scale to help purchase coverage. Additionally, effective within the next six months, children will be allowed to stay on their parent’s insurance until 26 years of age. Lastly, Medicaid is expanded to cover everyone below 133 percent of the federal poverty level (around $14,000 for a single person).

Market Reforms

Some of the most popular parts of the law are reforms on the health insurance market. The law eliminates lifetime caps on health insurance coverage. It ends the process known as rescission, where insurance companies review and nullify benefits after someone makes a claim. Lastly, the law eliminates pre-existing condition exclusions for children effective six months after enactment and over the next couple of years does the same for adults. In the meantime, it creates a high-risk pool for people to get coverage if they are denied for a pre-existing condition. Therefore, being born early will no longer mean that Sarah cannot purchase health insurance coverage.

Changes to Medicaid

Medicaid has been plagued by poor payments to doctors and that has limited the number of doctors willing to participate in the program. Medicaid payments in Michigan this year reached a new low of 63 percent of what Medicare pays for the same service. Healthcare reform, over the next few years, makes Medicaid payments for primary care doctors equal to Medicare payments. Additionally, it provides increased payments to all primary care doctors and to general surgeons who practice in underserved and rural areas.

Children

The law provides funding for the successful Children’s Health Insurance Program through 2016. Importantly, it provides preventive services for children at no co-pay in private and public insurance policies. So Sarah, no matter which insurance her family chooses, would be able to get coverage for preventive services like vaccines with no co-pay.

Seniors

Any senior who is enrolled in the Medicare prescription drug plan undoubtedly knows about the “doughnut hole.” The “doughnut hole” refers to the point in between were Medicare pays for drugs and where it picks up again for catastrophic coverage. This hole in coverage leaves seniors to cover nearly several thousand dollars until they reach catastrophic coverage. Seniors who are more likely to have chronic medical conditions such as diabetes, high blood pressure and heart disease are left to choose between paying for medicines to keep them alive and paying for rent and food. Health reform fills the doughnut hole over the next several years, beginning with a $250 rebate this year and a 50 percent reduction in prescription drug costs in 2011.

Costs

According to the non-partisan Congressional Budget Office, the law is estimated to cost $938 billion over the next 10 years and over the same time, reduce the budget deficit by $143 billion. Also included are multiple pilot projects to investigate ways to reduce costs, including everything from medical malpractice reform, to paying doctors and hospitals based upon quality and to routing out waste and fraud in the system.

While no law is perfect, health reform provides much needed care to our neighbors. Over 30 million Americans, just like Sarah, will now be able to see a doctor when they need help. Moreover, those who already have coverage will have increased protections and the security of knowing if they lose their job they don’t have to lose their health insurance.

Dr. Stephen Patrick is a House Officer in the Department of Pediatrics and Communicable Disease at C.S. Mott Children's Hospital, University of Michigan.

Comments

Anonymous Due to Bigotry

Tue, Mar 30, 2010 : 7:31 a.m.

I personally find that most doctors are very ignorant when it comes to political issues. I don't buy the idea that having a medical degree makes one educated in anything other than medicine. I don't really expect doctors to have a very solid understanding of the consequences of various laws even when it comes to things that are medical-related. Some of the simplistic reasoning that I encounter from doctors is essentially along the lines of "I see all these bullet wounds in the ER. I bet if we pass stronger firearm regulations then I'll see fewer of these!" or "Inanimate guns sound like pathogens that force people to commit violence, so lets try to use epidemiological models to show that reducing these pathogens will reduce violence." It's like they think that an MD makes one an economist or criminologist.

Linda

Tue, Mar 30, 2010 : 12:27 a.m.

I was hoping Dr. Patrick would comment. Thank you for responding and providing some background on your reasons for writing this article. Once I read the title, I knew many of the comments would be negative. However, as with any issue there is more than one side to the story. I really do hope this healthcare reform law works out and look forward to the positive changes we will be seeing in the future.

annarbor28

Mon, Mar 29, 2010 : 12:08 p.m.

Insurers today came out and said that they are not required to write new insurance for children who have preexisting conditions. The bill was written in a way that excludes this until 2014, as it does for adults. So although they cannot in the meantime write insurance that excludes preexisting conditions of children, they are able to just not write the policy at all. Good work Dems, that is something you have been campaigning on. I would have thought there were enough lawyers to write legislation properly, with your intent. Now they will dictate our health?

kiddoc

Mon, Mar 29, 2010 : 11:59 a.m.

... for some reason my response was cut off before. As I was saying, the error was in my response, not in the editorial itself. There is a growing body of evidence that those who are, particularly underinsured, are not accessing needed vaccines. It is true that many children are eligible (that's the misstep in the response), but certainly not all children are getting those vaccines. Regardless, this is really a small point. The editorial is what it is. It was written to be informative based upon facts within the bill.

kiddoc

Mon, Mar 29, 2010 : 11:58 a.m.

... for some reason my response was cut off before. As I was saying, the error was in my response, not in the editorial itself. There is a growing body of evidence that those who are, particularly underinsured, are not accessing needed vaccines. It is true that many children are eligible (that's the misstep in the response), but certainly not all children are getting those vaccines. Regardless, this is really a small point. The editorial is what it is. It was written to be informative based upon facts within the bill.

annarbor28

Mon, Mar 29, 2010 : 11:35 a.m.

An error such as that by a Pediatric Resident in training (I assume that's what a "House Officer" is, throws into question your entire editorial. You used a sob story that was totally false to justify a trillion dollar bill. Unfortunately, most of the Dems' sob stories about children have turned out to be false. Honestly, I would concentrate on your training and on honing your research and clinical skills before trying to be a health policy hotshot.

kiddoc

Mon, Mar 29, 2010 : 8:06 a.m.

... I did make an error in responding about vaccines. All children

annarbor28

Mon, Mar 29, 2010 : 12:29 a.m.

Rain: I think that they may have put the $400 billion Medicare cuts to doctors into the calculations, and since everyone expects that to be restored, that will change the accounting again, more for a negative balance. They are cutting HSA accounts over time, and making massive cuts to mental health and other areas of Medicare. Perhaps they think that more people will buy insurance, instead of paying penalties and waiting until they are sick. The states are trying to impose new taxes, such as on services, to support Medicaid and other state programs. Also, the Obama administration did not anticipate the billions dollars of write-downs that most major corporations are now taking, which will drastically reduce corporate taxes collected. There is no way for this to be a self-supporting program. Basically everyone is penalized, corporate and individual, except the poor, who will be heavily subsidized. There are no rewards for healthy life-styles, in fact, the more educated and affluent with often better health habits will be heavily subsidizing those who are more likely to smoke, overeat, etc. So the middle class will be both overtaxed and more stressed. A subsidy or tax credit for good BMI, exercising, low cholesterol, etc would have been appreciated. Several corporations do that with great success, but the Obama administration must not have found that politically expedient. Same with tort reform, and a step towards less defensive medicine being practiced. There are a great many holes in this very costly bill. It does not favor educated working people, except government policy makers and lawyers.

Ram

Sun, Mar 28, 2010 : 10:25 p.m.

I don't understand how this bill is supposed to reduce the deficit. I attempted to read the CBO reports myself but it didn't match up with the actual bill in terms of the numbering of the sections so it was impossible to see where the savings were coming from. I'm disappointed there in the sense of government transparency. Anyways, my point is this: How can the Federal Government provide Health Coverage to 30 million Americans at a negative cost to the national budget? So far, the answer I've found is new and/or higher taxes.

annarbor28

Sun, Mar 28, 2010 : 8:22 p.m.

kiddoc: Contrary to your representation, VFC vaccines are easily available for any child who does not have access to vaccines otherwise. This is one of the biggest problems with health care legislation, is that people with very little experience or knowledge of health care delivery, who are often young and inexperienced, write legislation with very little realization of what they are doing. You could have looked up the rules and availability of VFC vaccines for the child you cited, as well as your reply, before disseminating false information, especially as you and others are using cheap emotions about kid's vaccines to try to pass legislation, based on untrue information. Health care legislation and policy is full of these examples. Below are the regulations of VFC. Please get to know them before you make statements concerning US vaccine policy. VFC is a very generous program, that actually has led to controversy about the forced lowering of wholesale vaccine prices to the government, thereby increasing prices to private practitioners and discouraging vaccine development. But overall, it does a lot for children in providing vaccines. Vaccines for Children (VFC) Overview Children through 18 years of age who meet at least one of the following criteria are eligible to receive VFC vaccine: Medicaid-eligible: A child enrolled in the Medicaid Program (for the purposes of the VFC Program, the terms Medicaid-eligible and Medicaid-enrolled are equivalent and refer to children who have health insurance covered by a state Medicaid Program). Uninsured: A child who has no health insurance coverage. American Indian or Alaskan Native: As defined by the Indian Health Services Act (25 U.S.C. 1603). Underinsured*: Children: o Who have commercial (private) health insurance but the coverage does not include vaccines. o Whose insurance covers only selected vaccines (VFC-eligible for non-covered vaccines only). o Whose insurance caps vaccine coverage at a certain amountonce that coverage amount is reached these children are categorized as underinsured. *Underinsured: Underinsured children are eligible to receive VFC vaccine only through a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) Provider Responsibility to Screen for VFC Eligibility Screening to determine a childs eligibility to receive vaccines through the VFC Program must take place with each immunization visit. The Patient Eligibility Screening Record should be updated if the status of the patient changes. Maintain patient eligibility screening records on file for a minimum of three years after the last shot date on record. The Patient Eligibility Screening Record provides a means of recording parent responses to VFC eligibility questions. The parent, guardian, or provider may complete this form (see Appendix 2). Verification Verification of parent/guardian responses is not required. Charges and Fees for Immunization of VFC-Eligible Clients Providers may not charge VFC-enrolled patients for the cost of a vaccine provided by the VFC Program. However, providers may bill office visits and Medicaid and/or Medicaid Health Maintenance Organizations (HMOs) for vaccine administration fees. Families not covered by Medicaid or Medicaid HMOs may be charged a vaccine administration fee. This administration fee should not exceed the maximum regional administration charge (see Appendix 2). The provider will adjust this fee based on on the familys ability to pay. Providers may not refuse the administration of a vaccine to a VFC-enrolled client due to an accompanying adults inability to pay an administration fee.

kiddoc

Sun, Mar 28, 2010 : 4:03 p.m.

Dear all, Thanks for your thoughtful responses. I hope that we can continue a thoughtful conversation about facts and not make assumptions about peoples personal motivations. I assure you that I have voted for Republicans and Democrats. For me personally, this is not about politics, it is about members of my family and patients who have gone without needed care because of our health system. I was asked to go to the White House, a trip which I paid for personally, after sharing my mothers story in an article which was in the national press. I am also a member of the American Academy of Pediatrics and the American Medical Association both of whom support this legislation. So please, lets discuss the issues instead of making broad assumptions about those speaking. I was asked to write this as part of a pro/con series. I wrote the pro, someone else was to write the con. I assumed that a con piece would be in the same paper, but Im assuming that will follow in the next print issue? Regardless lets talk about some of the issues that have come up: First, CHIP or MiChild is not open to every child. You must qualify by income. States have the flexibility to cap this program as well. Michigan does a great job providing coverage for children, other states struggle with this. Washtenaw County Health Plan as is in the name is only in Wasthenaw County and is fairly unique. Vaccines so for the poor, you are correct that vaccines are provided by the government through a program called Vaccines for Children. Certainly many children do not qualify for this program. Costs. They are a huge concern for everyone. The cost estimates by the CBO and by groups on both sides are simply that estimates. It is our job to hold our public officials to the fire to make sure that as this bill is implemented, decisions are made which make sense and are cost effective. There is a lot in the bill to address cost is it enough, no. The bill does create numerous pilot projects to try doing things in a more cost effective manner. Medicare cuts. I agree with you on this point. Theres no way Congress is going to let a 21% cut go this year. What I expect, however, is that they will pass a band-aid as they have in years passed which is cheaper than fixing the overall problem. When I was in graduate school a few years ago I remember a specific slide on the history of health reform far right all free market, far left single-payer. Where does this bill fit somewhere in the middle. I appreciate the feedback and comments from each one of you. Isnt that what makes our country great! I trust that as the bill rolls out over the next several years all of us will make our voices heard. Thank you for the opportunity to share, Stephen

clara

Sun, Mar 28, 2010 : 3:24 p.m.

Both these doctors are members of Doctors for America, formerly Doctors for Obama. Th D for A and D for O have supported whatever plan the Obama administration has put forth since 2008.

clara

Sun, Mar 28, 2010 : 3:15 p.m.

Zeb admits she/he is a member of Doctors for America, just like Dr. Patrick. This organization has backed whatever reform the Obama administration has offered. Their goal is 'reform' period. They have letters you can cut and paste to the editor. They say they have 450,000 members so I guess that is where Zeb got 1/2 million. They work with MoveOn.org DforA did an internal survey and of about 800 doctors 92% were in favor of some type of change in health care, so the 1/2 million number (450,000 number) would be more like 400,000 in favor. Of course, another page on their site says they have 13.5 thousand physicians. Doctors for America is not listed with the BBB or the State of Michigan. CNN and NPR quote them regularly as medical experts. "Our goal is to pass strong health reform legislation this year so everyone has access to affordable, high quality care and so we can focus on taking the best care of our patients. " May 2009: Sen. Max Baucus and the Center for American Progress Action Fund are announcing a new group on a conference call later this morning: Doctors for America, which is a reincarnation of Doctors for Obama, an arm of the Obama campaign that boasted more than 10,000 members.

annarbor28

Sun, Mar 28, 2010 : 2:38 p.m.

Hey Zeb: when did you make up your stat that 0.5 millions doctors support THIS health bill just passed in this country? Is it from ACORN??? Why doesn't the government forgive medical students loans of $250,000 for each poor soul that I know in medical school or residency programs? Underwrite the cost of medical school so that martyrs can go into medicine who don't need to earn money? Support practices other than Medicaid mills, so that doctors don't leave medicine or retire? Health insurance companies should be made nonprofit. Their profits are outrageous. But to assume that doctors can work for very little with their overhead costs and debts is overly simplistic. Just as long as you live in a room for $300/month, don't have kids, go on food stamps and shop at Wal-Mart, you will surely be able to make it in medicine. Oh, and default on your student loans, that'll be great for you, too. Make sure your sister is a bankruptcy lawyer who can take your case for free. To imply that doctors are not dedicated if they don't support this bill that rewards tort attorneys more than physicians and other providers is to buy the party line of the lawyer and health-insurance company backed Obama cohorts. Now try living with 21% Medicare cuts that will be in effect this week.

zeb

Sun, Mar 28, 2010 : 2:17 p.m.

over half a million doctors support reform, because we know it works, we know it has to happen, and we need it now. a lot of us are ok with an incremental decrease in our pay, and know that when the whole delivery system makes more sense, our work life will improve, and so will our ability to help our patients. i went into medicine to increase health and well being in the world, and have control over my work life. working for insurance companies allows me to do neither. health reform improves my chances of doing so. for those of you who want the government out of your lives, go somewhere like Pakistan and live for a while. In Pakistan people rarely pay income tax, government schools are a joke, and let's not even talk about health care.... human misery surrounds even the most fortunate of billionaires in Karachi, and they must either leave, and go to England, Canada, US, or Australia, or numbly parade their riches in huge jeeps with security guards and kalashnikovs outnumbering passengers.... See More Government is not perfect. after all, they take MY hard earned money and use it to kill children all over the world and pad the pockets of Blackwater and Cheney and the dynasties that own the corporate piracy machine. But at least in our constiturional federal government the pretense to duty, moderation, and responsibility dampen the natural human impulse to accumulate and hoard resources. I've worked with BCBS and Cigna execs, and I've worked with Obama. I'd rather work for Obama. And I'm out there in the trenches delivering health care every day. Doctors for America www.drsforamerica.org We Care. We know. Reform Saves Lives.

Mick52

Sun, Mar 28, 2010 : 12:47 p.m.

I have to agree with in4mation. This bill is an insurance regulation bill and does little to lower costs, but likely will raise costs. How ironic that a physician wrote this opinion piece. Insurance companies are taking the hits when the fact is that health care is very expensive. Perhaps we should look at HC providers rather than insurance companies to lower the costs. Take a look at what physicians are paid in Great Britain, with National Health Service, a single payer system. I did not note anything in Dr. Patrick's opinion as to how much of a pay decrease he and his colleagues will offer up to lower HC costs. Ditto the nurses, techs, Phys Assts, and everyone else in our systems. A big failure of congress from the start was failing to properly identify the numbers: # who don't have care due to income, # who have it but trouble affording it, # who can afford it but don't buy it. And what will be done re: illegal immigrants and the #s. Also, if we cover illegal immigrants will that increase the numbers coming over the borders? Once the numbers are identified, some estimates can be computed in re to costs. Due to unemployment these numbers have increased, but are still far fewer than those covered, most of whom do not want what they have changed. Which is what the President promised, but should have known is not possible. Those without who cannot afford it will be able to do little to assist w/costs, so to cover them will require big bucks from taxes or more likely, premium increases to those who pay. Ditto for those having trouble with the cost. This bill requires insurers to accept all apply, including those w/pre-existing conditions, they will have to estimate their future costs. Those folks will require more expensive care, which will drive up premiums for everyone. If the premiums go up, less people will be able to afford it. I fear too many people are going to find out their new HC is not going to be free. Another item is private HC, both insurance and hospitals, compared to non profit insurance companies and hospitals. For profits have the burden of maintaining profits that will satisfy those who profit. Is this bad? It does add to costs, but perhaps those hospitals would never have been built absent investors. This is getting long, but another item of interest. If you leave your job you can keep your insurance. Sounds like an extension of COBRA, which allows you to keep your insurance for a while, But you have to pay for it, no more employer contributions. So I wonder if this law that lets you keep your children on your insurance, requires your employer to extend employer contributions too. Have not anything on this. If it is required, employers are saddled with that bill, and does this law prevent employers from dropping dependents from coverage? If not you get to cover your kids but with much higher premiums (still lower than open market rates, probably). My favorite problem with this bill is the pre existing ill crowd. Suppose a person who can afford insurance refuses to buy it and pays the fine that may be unconstitutional, but lets say it is. Then he gets hurt/ill and needs an expensive surgery. Will he be allowed to go buy insurance, get his operation, and then stop paying his premiums? What a bargain, 2 or 3 months of premiums and your bulk of your care is paid for by those still paying premiums. You might be able to pay $1800 for a $25,000 surgery, based on a $600/mo insurance plan. If the premiums are lower, then its more of a bargain. I would think the "didn't by insurance fee/tax" should be equal to what your premiums would cost for an entire year to prevent this from occurring and force people to buy insurance. So while I see some insurance co regulations, I see a lot of holes that will cost folks more. Face it people, HC is very expensive and with quality the costs go up. Note that no politicians are saying "high quality health care," they are saying "quality health care." For higher quality you must pay a lot. Its expensive and not a whole lot can be done to make it "affordable," without huge increases in fees/taxes. Sorry this is so long.

The County Public Health Departments generally give out vaccines free, so the child cited above could have received her vaccines. Also, I wonder if the saving they project include the 21% cut in Medicare payments to doctors that Congress has not restored. Good luck finding a doctor who takes Medicare. Also, does this mean Medicaid payments will be at this lowered 21% Medicare payment level?

Anonymous Due to Bigotry

Sun, Mar 28, 2010 : 8:54 a.m.

If the current "health reform" plan is based on the Massachusetts plan, that's a bit worrisome since the Massachusetts plan hasn't worked out so well. It's increased the cost for everyone and placed more of a burden on the middle class.

stunhsif

Sun, Mar 28, 2010 : 8:23 a.m.

How this Dr. can say what he says with a "straight face" amazes me. Most of us will pay much more and get far less.

voiceofreason

Sun, Mar 28, 2010 : 7:50 a.m.

clara, Now that you mention it, Dr. Patrick is the same guy. His role as a government employee has apparently expanded into being the local propaganda czar.....

clara

Sun, Mar 28, 2010 : 7:42 a.m.

Is this the same Dr. Stephen Patrick who was one of the prop stand ins at the White House wearing his white coat? Is this the same Dr. Stephen Patrick who is a member of "Doctors for America"? In Michigan there is the MIChild program. It already covers: Regular checkups Shots Emergency care Dental care Pharmacy Hospital care Prenatal care and delivery Vision and hearing Mental health and substance abuse services The State of Michigan also offers the Healthy Kids program which covers many more items than listed above. In Washtenaw County there has been in place the Washtenaw Health Plan (WHP) and Washtenaw County Prescription Plan. Washtenaw Health Plan covers medically necessary health care services including: Doctor/Clinic Visits Outpatient lab and X-ray tests Prescriptions from pharmacies if on the list of covered drugs Limited mental health services Hospitalization at University of Michigan Hospital or St. Joseph Mercy Hospital in Washtenaw County ER visits for true emergencies